Published online by Cambridge University Press: 05 November 2015
This chapter aims to provide the reader with an introduction to the management of children with cancer. Contemporary reviews and resources will be referred to as appropriate. Radiotherapy is an important component of the treatment for many childhood tumours and this may involve advanced techniques including brachytherapy or protons, sometimes requiring referral to another centre or even abroad. Many different healthcare professionals are involved in the delivery of care, coordinated in the UK by specialised multidisciplinary teams (MDTs) at one of 19 principal treatment centres, often in collaboration with shared care units closer to home.
Paediatric cancer is uncommon. Of the 280,000 patients diagnosed with cancer in England in 2012, only 1303 were children (0.5%). The incidence of some childhood cancers has increased marginally over the last 40 years, but death rates have declined dramatically for all non-CNS childhood cancers. With cure rates now over 70%, the prevalence of paediatric cancer survivors in the population is increasing rapidly, posing challenges for the management of cancer survivorship and the late effects of treatment. The incidence of cancer between the ages of 10 and 65 is well modelled by a 10% increase per annum, which equates to a 10-fold increase every 25 years. Given the relative rarity of paediatric cancer, it is still unusual to encounter an adult survivor of paediatric malignancy, but will become more common.
An important challenge in treatment is to minimise toxicity while maximising the chance of cure, leading to a risk-based stratification of treatment intensity, including for radiotherapy. As a result, most paediatric cancer is delivered using nationally or internationally agreed protocols. Radiotherapy has significant late toxicity as it reduces the natural growth seen in childhood, and, because of the long life expectancy of survivors, it may cause radiotherapy-induced second malignancies.
The radiotherapy pathway
Giving radiotherapy to children is complex and requires a team of clinical oncologists, therapeutic radiographers, mould room staff and play specialists, together with nurses, anaesthetic staff, physicists, dosimetrists, and psychologists or psychotherapists.
Play therapy is important in preparing children for radiotherapy. If the trust and cooperation of a younger child can be gained, treatment may not require a general anaesthetic.